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Background: To paraphrase the Institute of Medicine’s (IOM) 2002 report on public health: what can we as a society do to fulfill our ongoing interest in assuring the conditions for people to be healthy?

Decisions that governments and corporations make every day benefit some and burden others. Unfortunately, they often reinforce class, racial and gender inequities that contribute to unequal patterns of illness and premature death. Building a social movement that can advocate effectively for more equitable social and economic policies is critical to changing our economic, physical and social environments so that they promote rather than threaten our health.

In other words, tackling health inequities is unavoidably a matter of politics; of engaging in struggles over how we want our government to allocate resources, regulate corporate power, and implement the principles of democracy.

Tony Iton, MD, director of the Alameda County Public Health Department in California, points out that social policies that produce and reproduce class and racial inequality have, over time, “taken many forms, including racially restrictive covenants on property, economic redlining in banking practices, school segregation, [unfair] housing and urban renewal policies, disinvestment in public transportation, discriminatory zoning practices, law enforcement racial profiling, [discriminatory] incarceration policies, and other deliberate governmental policies and practices.”

But we’ve also made many changes during the last century that have improved health equity by improving peoples’ lives: the eight-hour work day, universal public high school, the right to collective bargaining, social security, civil rights, environmental standards... There’s no reason why we can’t do so again.

Some of these policy changes will be driven locally, some on the state level, others on the federal level. In general, they fall within three categories:

• Tackling inequality and improving living standards. These policies aim to close the gap between the rich and the rest of us, and between white people and people of color, such as living wage jobs, more equitable tax policy, affirmative action and family supports.

• Protecting those at the bottom of the pyramid. These policies protect under-resourced households and communities from health threats posed by the chaos and uncertainty of free markets. They promote not only additional programs and services, but more equitable allocation of public resources through needed social investments (such as quality schools, affordable housing, and public transit) so that the means for achievement are more available to those with fewer individual resources.

• Reforming decision-making. These policies aim to open and democratize decision-making processes that too often are dominated by concentrated economic and political power. Successful policy change depends more than anything else on those most affected by injustice working together to set priorities, generate solutions, make their voices heard, and to organize effectively to hold government accountable.

How does one advance “health in all policies”? How can local, state and national public policy action in support of health equity be brought about? What is the legislative agenda? What are the policy and program levers? What does this imply for organizations’ own strategies and structures? How do engaged groups communicate with each other and so avoid having to climb the same learning curve over and over again? How can a comprehensive and sustained health equity focus and movement best be built? Can these initiatives be brought together under one health equity national strategy, umbrella or coalition? Should they?

The articles and media in this “policy and change” section address some of the policies and strategies tackling patterns of advantage and deprivation, of hope and despair, and of health and illness.

The Global Health Equity Group (GHEG) is concerned with research, training and knowledge translation in matters relating to the unequal distribution of power, income, goods, and services (structural determinants), the consequent unfairness in the immediate circumstances of people's lives - their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities (daily living conditions), and the effects on health inequities - within and between countries.

The GHEG website houses a number of research and policy-related documents.

The Disparity Reducing Advances Project (the DRA Project) is a multi-year, multi-stakeholder project developed by the Institute for Alternative Futures (IAF) to identify the most promising advances for bringing health gains to the poor and underserved and accelerating the development and deployment of these advances in order to reduce disparities. The purpose of this memo is to serve as a resource on the state of the health equity movement by compiling information on activities and reports around the U.S. This memo should be used as a way to quickly learn about the current happenings in the health equity movement, and all of the information provided is hyperlinked to provide more information regarding the organizations, conferences, and publications noted.

Contains a brief history of the national living wage movement, background materials such as ordinance summaries and comparisons, drafting tips, research summaries, talking points, and links to other living wage-related sites. (Please also visit www.raisewages.org for the latest on minimum wage ballot initiatives across the country.)

REPORT from the Secretariat of the WHO Commission on the Social Determinants of Health, March 2005

A background paper prepared for the first meeting of the Commission, with 20 pages of history of different understandings of health over the past century, and international trends and movements in recent decades to incorporate social concerns into public health policy and interventions. The report also contains about 10 pages on the aims and objective of the Commission itself.

Public policy change is critical to achieving health equity. But how can organizations use the series to educate, organize and advocate for changes that will make a difference? The UNNATURAL CAUSES toolkit provides facilitation tips, background, sample agendas, and guidelines for planning an effective screening – one that not only deepens understanding of issues but serves as a step towards further involvement.

The Office of Minority Health and Public Health Policy released this report compiling ideas for health equity promotion generated during statewide community screenings of UNNATURAL CAUSES. Their site also contains resources for promoting public awareness about health inequities.

A straight-forward guide to community-based policy advocacy. Includes information on identifying the best policy strategies for your community, building coalitions, communicating with public officials, and policy options beyond legislation. Also includes inspiring examples of successful community-based policy reforms.

The “Place Matters” episode of Unnatural Causes focuses on the city of Richmond, California. Much has happened in Richmond since the film’s release, including a 45% reduction in homicides and an attempt to pass the nation’s first soda tax (it lost thanks to millions of dollars spent by the soda and beverage industry).

Now UC Berkeley is planning a new campus in Richmond. This report by the Haas Institute for a Fair and Inclusive society looks back at Richmond, and forward to a unique opportunity to build new models of partnership ensuring the new Berkeley campus expands opportunity and community health for all. There are lessons here for how campuses, hospitals and other anchor institutions in marginalized communities across the nation can serve inclusion and equity, not displacement.

"ARC's vision for racial justice is changing the way our society talks about and understands racial inequity. ARC conducts research to expose the subtle racism of laws and regulations that result in real hardship for Black, Latino, Asian and Native communities. We use public policy as a key tool to repair these historic injustices by designing and implementing creative solutions to contemporary problems. Through advocacy leadership we train a new cadre of journalists, community organizers and elected officials to make these solutions real. Finally, ARC works through journalism and the mass media to push a society silenced by guilt and confusion toward a real discussion of racial justice in the 21st century."

A report on the landscape of statewide conditions as well as opportunities and challenges for building grassroots power and influence at the state level, using the framework of social justice. The report is designed to inform legislators and policymakers of the history of neglect and inadequate enforcement of environmental protections in California, and to identify policy, legislative, program, and investment gaps, and as a reference document to support direct organizing efforts and coalition-building. The reports contains recommendations and strategies for improving environmental justice in the state.

This brief offers a framework for strengthening communities to improve the health and well-being of residents. One of four publications that outline strategies for achieving better health through community-focused solutions, this report is based on a review of the literature as well as on interviews with African American and Latino community health leaders (or those serving African American and Latino populations) and elected officials from across the country.

CER advocates reforms that produce high standards, accountability and freedom, such as strong charter school laws, school choice programs for children most in need, common sense teacher initiatives, and proven instructional programs. Its Washington, DC-based team and state and local partners advance the mission by: making parents better advocates for their children; giving lawmakers knowledge they need to make smart decisions; providing school-based reformers the tools to promote positive change; and building and strengthening education reform leaders in the states.

Since 1971, the Center for Science in the Public Interest (CSPI) has been a strong advocate for nutrition and health, food safety, alcohol policy, and sound science. CPSI has helped pass several important food safety and labeling laws, and is currently working to ban junk food in schools nationwide, rid the food supply of artificial trans fats, provide responsible information about agriculture biotechnology, and expose corporate influence over government decisions and policy making.

This book is designed to present cutting-edge research and policy analysis to a wide non-specialist readership of students, professionals and policy-makers. It brings together in one volume new perspectives on the conceptual foundations of health equity, empirical evidence on the scale and nature of inequities in health in twelve countries around the world, and assessments of the associated policy developments and their implications for the future.

See especially, "Social Inequality and the Burden of Poor Health,” Kubzansky, et. al.

Seven unions and six million workers united in Change to Win in 2005 to build a new movement of working people equipped to meet the challenges of the global economy and restore the American Dream in the 21st century: a paycheck that can support a family, affordable health care, a secure retirement and dignity on the job.

The American Dream is under threat today as never before in our lifetimes. To learn more about this challenge and what working people are doing to meet it, see The American Dream Survey, our ongoing research project on the state of the American Dream.

eBOOK by Larry Adelman, Voice Matters: An Anthology of Public Relations with a Conscience

Filmmaker Larry Adelman and offers a powerful argument that a zip code is a better predictor of health outcomes than genetic code, diet and even medical care. Adelman, the creator of Unnatural Causes: Is Inequality Making Us Sick?, kicks off the first edition of the Voice Matters eBooks series with a call to arms for health equity in the world’s richest nation.

A Child Friendly City is actively engaged in fulfilling the right of every young citizen to: Influence decisions about their city: Express their opinion on the city they want; Participate in family, community and social life; Receive basic services such as health care and education; Drink safe water and have access to proper sanitation; Be protected from exploitation, violence and abuse; Walk safely in the streets on their own; Meet friends and play; Have green spaces for plants and animals; Live in an unpolluted environment; Participate in cultural and social events; Be an equal citizen of their city with access to every service,regardless of ethnic origin, religion, income, gender or disability.

This report finds that across metropolitan America, black and Hispanic children face particularly severe challenges. Inequalities go far beyond what can be explained by income differences, as poor black and Hispanic children tend to encounter environments considerably worse than poor white and Asian children. Yet the very conditions that contribute to these inequalities suggest some possible policy solutions.

The analysis contained in this report is derived from diversitydata.org, a website using data from multiple sources to profile U.S. metropolitan areas's indicators on many dimensions of well-being, including housing, neighborhood conditions, residential integration, education and health.

A project of the World Health Organization (WHO), the Commission on Social Determinants of Health (CSDH) supports countries and global health partners to address the social factors leading to ill health and inequities. It draws the attention of society to the social determinants of health that are known to be among the worst causes of poor health and inequalities between and within countries. The determinants include unemployment, unsafe workplaces, urban slums, globalization and lack of access to health systems.

The Web site also contains final reports from the different knowledge networks, as well as additional background articles and resources.

REPORT from the Applied Research Center and Northwest Federation of Community Organizations, 2005

Unhealthy neighborhoods and lack of health care contribute to poor health, and they are unequally distributed. People of color are exposed to greater threats and have less access to quality care. This report outlines causes of inequities as well as promising initiatves around the country to combat them. One chapter focuses on Tohono O'odham Community Action (www.tocaonline.org) an organization co-founded by Terrol Dew Johnson, who appears in the episode "Bad Sugar."

The Robert Wood Johnson Foundation Commission to Build a Healthier America looks beyond the medical care system to investigate how factors such as education, environment, income, housing and personal health choices impact the health of all Americans and ultimately provide better opportunities for Americans in every community to grow up and stay healthy. Even with decades of effort to improve America’s health care system, too many Americans still die earlier than they should, and too many are suffering from conditions that can be prevented.

The RWJF Commission released a report in February 2008, Overcoming Obstacles to Health, that provides a profile of the current state of health in America.

Communities Taking Action is a collection of profiles developed by Prevention Institute that showcase successful community initiatives aimed at improving health equity. These profiles are meant to demonstrate key steps to creating healthy, equitable environments and inspire similar action in other communities and locales. Click on any of the map icons to view and browse the profiles.

The Community Food Security Coalition (CFSC) is a North American organization of 325 groups working in social and economic justice, environmental issues, nutrition, sustainable agriculture, community development, labor, anti-poverty, anti-hunger, and other areas. With the ultimate objective to build strong, sustainable, local and regional food systems that ensure access to affordable, nutritious, and culturally appropriate food to all people at all times, they provide a variety of training and technical assistance programs for community food projects; support the development of farm to school and farm to college initiatives; advocate for federal policies to support community food security initiatives; and provide networking and educational resources.